中西医诊治肝硬化腹水进展*

doi:10.3969/j.issn.1672-5069.2018.03.049

摘要/Abstract

摘要： 腹水是肝硬化最常见的并发症。肝硬化腹水形成的机制尚未完全阐明,目前认为门静脉高压是形成腹水的主要原因。腹水的诊断可依据病史、查体和腹水常规检查。对于肝硬化腹水患者,采取及时有效的药物治疗可以提高患者的生活质量和生存率。一旦出现肝硬化晚期并发症,最终需要进行肝脏移植,故腹水的治疗越早越好。西医治疗腹水主要为限钠饮食、应用利尿剂、普坦类药物和白蛋白。顽固性腹水可以采用腹穿大量放液术、经颈静脉肝内门体支架分流术、腹腔静脉分流术等手术治疗。国内外越来越多的文献报道中医药联合利尿剂治疗肝硬化腹水取得较好的疗效。但目前中医辨证理论和疗效评价体系尚不统一,可重复性差。因此,拟定一套规范化和可重复性强的综合治疗方案,对于提高肝硬化腹水的临床疗效具有重要的现实意义。本文将重点介绍肝硬化腹水的诊断及治疗管理进展。

关键词: 肝硬化, 腹水, 诊断, 治疗

Abstract: Ascites is the most common complications and is mainly arisen from portal hypertension. The diagnosis of cirrhotic ascites can be determined by the history,physical examination and ascitic uid analysis. Effective treatment of cirrhotic ascites improves the quality of life and survival rate. Although the prognosis of ascites can be improved by some treatment options,once complications occur,the prognosis is poor. Liver transplantation remains the ultimate option of treatment. So,the earlier treatment begins,the better the patient’s prognosis. Western medicine treatment include daily sodium intake limitasiton,diuretics,vaptans and serum albumin infusion. Refractory ascites can be dealt with large-volume paracenteses,a cell-free and concentrated ascites reinfusion therapy,a transjugular intrahepatic portosystemic shunt,and a peritoneo-venous shunt. More and more literatures at home and abroad report that Chinese medicine combined with diuretics in the treatment of ascites has better efficacy. However,the theory of TCM treatment and evaluation system are yet not validated up to now. It is of great practical importance to establish a standardized comprehensive treatment program for improving the clinical efficacy of ascites. The present review puts emphasis on the diagnosis and therapeutic management of cirrhotic ascites.

Key words: Cirrhosis, Ascites, Diagnosis, Therapy

刘红虹综述, 赵平审校. 中西医诊治肝硬化腹水进展*[J]. 实用肝脏病杂志, 2018, 21(3): 485-488.

Liu Honghong, Zhao Ping. Insight of diagnosis and treatment of ascites in cirrhotics with integrated traditional Chinese and western medicine[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(3): 485-488.

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